The proposed project represents the next step in treatment development of our manualized, culturally sensitive cognitive-behavior therapy for Cambodian refugees with PTSD who have had an incomplete response to medications and supportive psychotherapy. The initial treatment development was supported by a K award to the principal investigator (K23, MH066253). This will be the principal investigator's first independent R-01, hence meeting the NIH guidelines for new investigator designation. One recent survey found that over 50% of Cambodians in a community setting met PTSD criteria, and another survey, that over 50% of Cambodian patients in a specialty clinic still met PTSD criteria, even after years of treatment, including adequate trials of psychopharmacology and supportive therapy. Despite the ample evidence of the efficacy of CBT for the treatment of PTSD among English-speaking groups, there are only five controlled studies of treatment efficacy among refugee populations. Three of those five studies were conducted by our group (two among Cambodian refugees, one among Vietnamese refugees). There is no study of the efficacy of CBT for treating PTSD in a minority group in the United States, other than our three studies of Cambodian and Vietnamese refugees. In our preliminary study, we completed NIH-defined stages of psychosocial treatment development. Based on extensive research among Cambodian refugees, we developed a manualized treatment. Among Cambodian refugees, the treatment was piloted in a small randomized controlled trial (RCT), comparing to waitlist, and then, in a medium-sized RCT, also comparing to waitlist. In a small pilot, also a RCT comparing to waitlist, efficacy was demonstrated for Vietnamese refugees with treatment-resistant PTSD. In these studies, we found the manualized treatment to be well accepted and efficacious (with large effect sizes), as assessed by standardized assessment measures, such as the Clinician-Administered PTSD Scale (CAPS). The proposed grant would allow us to further investigate the efficacy of our manualized CBT intervention for Cambodian refugees with treatment-resistant PTSD, building on our earlier studies, by conducting the next logical step of empirical investigation: a comparison of our manualized treatment to another active treatment condition.